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Claims Research Jobs (NOW HIRING)

WebTPA

Claims Examiner I

San Antonio, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Health Advocate, Inc.

Claims Associate

$18.25 - $24.50/hr

Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue * Assist members with setting up payment arrangements which ...

Guidewell

Claims Examiner I

San Antonio, TX

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Guidewell

Claims Examiner I

San Antonio, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties ...

Health Advocate Solutions

Claims Associate

$18.25 - $24.50/hr

Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue * Assist members with setting up payment arrangements which ...

New

Sanford Health

Manager, Claims

Marshfield, WI · Remote

Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and ...

Sanford Health

Manager, Claims

Fargo, ND · Remote

Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and ...

Sanford Health

Manager, Claims

Fargo, ND · On-site

Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and ...

Sanford Health

Manager, Claims

North Sioux City, SD · Remote

Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and ...

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Claims Research information

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$11

$24

$42

How much do claims research jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for claims research in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What is a claims research professional?

Claims research professionals are specialists who investigate and analyze insurance claims to determine their validity and ensure compliance with policy terms. They gather information, review documentation, and may interview claimants or witnesses to verify details. Their work helps insurance companies prevent fraud, process legitimate claims efficiently, and resolve disputes. Claims researchers play a crucial role in protecting both the insurer and the policyholder by ensuring fair and accurate claim settlements.

What are the key skills and qualifications needed to thrive as a claims research specialist, and why are they important?

To thrive as a Claims Research Specialist, you need strong analytical skills, attention to detail, and knowledge of insurance or claims processes, often supported by a relevant degree or experience in claims management. Familiarity with claims management software, databases, and sometimes certification such as AIC (Associate in Claims) is typically required. Excellent communication, problem-solving abilities, and customer service skills help you excel when interacting with clients and resolving complex cases. These skills ensure accurate claim resolution, compliance with regulations, and a positive experience for policyholders.

What are some common challenges faced in a claims research role, and how can they be managed?

A common challenge in Claims Research is navigating complex policy details and incomplete or ambiguous documentation. Researchers must often communicate with multiple stakeholders, such as policyholders, adjusters, and healthcare providers, to gather missing information and verify facts. Managing tight deadlines while ensuring accuracy is also crucial. Building strong organizational skills and maintaining clear, professional communication can help address these challenges effectively.

What is the difference between Claims Research vs Claims Adjuster?

AspectClaims ResearchClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma or equivalent; insurance licensing often required
Work EnvironmentOffice-based, research-focused, often involving data analysisField and office-based, investigating claims and interacting with clients
Industry UsageInsurance companies, third-party administrators, claims research firmsInsurance companies, adjusting firms, third-party administrators
Common Search & ComparisonYesYes

Claims Research involves analyzing data and gathering information to support claims decisions, often working behind the scenes. Claims Adjusters evaluate and settle claims directly with policyholders, often working in the field. While both roles require insurance knowledge and certifications, Claims Research focuses on data analysis, whereas Claims Adjusters handle claim investigations and settlements.

Is claims research processing a stressful job?

Claims research processing can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The job often involves handling complex information and can require long periods of concentration, which may contribute to stress levels for some individuals.
More about Claims Research jobs

What are the most commonly searched types of Claims Research jobs?

The most popular types of Claims Research jobs are:

What job categories do people searching Claims Research jobs look for?

The top searched job categories for Claims Research jobs are:

Claims Research jobs near you
Infographic showing various Claims Research job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 1% As Needed, 85% Full Time, 11% Part Time, and 2% Contract. Highlights an 84% Physical, 4% Hybrid, and 12% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.

Claims Research Specialist

SOUTHEASTERN RETINA ASSOCIATES PC

Knoxville, TN • On-site

Full-time

Re-posted yesterday

Job description

About Us:

Southeastern Retina Associates (SERA), with 21 board-certified ophthalmologists specializing in the treatment and surgery for diseases of the retina, macula and vitreous, is one of the largest remaining physician-owned and independent retina practices in the country, and the most experienced retina team in East Tennessee. Since 1980, SERA has offered the most advanced surgical, injection and medical approaches to patients with all types of retinal conditions, including age-related macular degeneration (AMD), retinal detachment, diabetic retinopathy, macular diseases, retinal vascular diseases, ocular tumors, and ocular trauma. Our compassionate retina specialists combine cutting-edge science with a patient-centric philosophy to achieve the best possible outcomes.


POSITION SUMMARY

Assist with the revenue cycle management of SERA’s Billing Department with a primary focus on the resolution of error, rejected and delinquent claims. This includes, but is not limited to: reviewing claims, researching identified errors, compiling required documentation and preparing the appropriate correspondence to ensure payment.

ESSENTIAL FUNCTIONS
  • Maintain delinquent claims worklist queue and coordinate with fellow Claims Research Specialist.
  • Review and research delinquent claims and take all necessary actions and/or corrections to ensure claims payment.
  • Processing paper claims and electronically submitted claims including providing additional documentation as required by Carrier to ensure proper payment (Workman’s Compensation, skilled nursing facilities, etc.).
  • Electronic data input of secondary claims for carriers requiring on-line claim submission.
  • Answer incoming calls from patients, front desk staff and clinical staff as needed helping provide resolutions to current issues.
KNOWLEDGE/SKILLS/ABILITIES:
  • Requires in depth understanding of medical reimbursement and coding, including Medicare and Third-Party Insurance guidelines, with the ability to apply knowledge to daily responsibilities.
  • Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of TN, GA, VA and Federal payer regulations.
  • Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
  • Knowledge of business management and basic accounting principles to promote effective communication between Billing and Accounting.
  • effective relationships with patients, physicians, staff and other people contacted in the course of the work.
  • Proven records of attention to detail and commitment to accuracy in work performed including the ability to enter data accurately in end–user computer applications.

EDUCATION | EXPERIENCE

High school graduate or GED Equivalent.

Minimum 2 years’ experience in a medical billing office with knowledge of medical reimbursement and coding.


PHYSICAL DEMANDS AND WORK ENVIRONMENT

The Physical Demands and Work Environment characteristics described below are critical features of this job and are representative of those that must be met by an employee to successfully perform the essential functions. They may be subject to change at any time due to reasonable accommodation or other reasons.

TYPICAL PHYSICAL DEMANDS Work may require sitting for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, operates a calculator, telephone, copier and other office equipment as necessary. It is necessary to view and type on computer screens for long periods.

TYPICAL WORKING CONDITIONS Work is performed in an office environment. Work involves frequent contact with staff members and physicians. Work may be stressful at times. Interaction with others is constant and interruptive. The noise level in the work environment is usually moderate. Occasional evening or weekend work as needed.

This description provides only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

It is not intended to be all-inclusive. The employee may be required to perform other reasonably related business duties as assigned.

SERA reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.

HIPAA: All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action ranging from a warning to termination depending on the level of violation.


This is not just a job—it’s a career opportunity. We are looking for individuals who want to grow, learn, and stay. We invest in our people with structured training, support, and advancement paths. This is an ideal opportunity for someone who wants to build a future in healthcare, not just collect a paycheck.

If you’ve moved frequently between jobs or are unsure about committing to a long-term position, this may not be the right fit. But if you’re eager to join a team where you can plant roots, develop skills, and make a difference, we’d love to meet you.